Provider Demographics
NPI:1013901479
Name:THUDE, NICOLETTE (ANP)
Entity Type:Individual
Prefix:MS
First Name:NICOLETTE
Middle Name:
Last Name:THUDE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 GEORGE BELL CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3955
Mailing Address - Country:US
Mailing Address - Phone:907-345-7082
Mailing Address - Fax:
Practice Address - Street 1:1651 GEORGE BELL CIR
Practice Address - Street 2:STE 900
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3955
Practice Address - Country:US
Practice Address - Phone:907-345-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
5502254OtherAETNA
AKNP04292Medicaid